Psoriatic Arthritis Blog

The Emotional Toll of Psoriatic Arthritis

The symptoms of psoriatic arthritis (PsA) are usually quite visible – painful, swollen joints, skin reactions and fatigue. Less apparent, but just as impactful, is the emotional toll the disease can take.

“They tell me that it’s taxing,” Julie Nelligan, PhD, a Portland Oregon-based psychologist, says of her psoriatic arthritis patients. “They may say things like, ‘Nobody understands me, I feel like I’m not contributing. I’m lonely, I’m anxious because I don’t know when I can get things done and I can’t commit to doing things,’” she adds.

Living with a disease that has both subtle and obvious symptoms can be a double-edged sword. When you don’t have any noticeable skin lesions, friends and family might not realize how much pain you’re in, and fail to take your illness seriously.

When you do have obvious plaques, you have to deal with the embarrassment and constant fear of others judging you. “It’s pretty devastating to patients because some of them have had the experience of salons refusing service. Swimming pools and gyms have kicked them out,” Nelligan says. Fear of judgment and low self-esteem can keep you at home; isolated and lonely.

Psoriatic arthritis can affect every aspect of your life: work, exercise, dating, traveling and doing many things you once loved. “You can often feel like you don’t fit in or you can’t do your job, which can be pretty depressing,” says Nelligan.

It seems that the mechanism of the disease affects your emotions directly, too. “It appears that the same inflammatory substances that create the warm joints, swelling and pain also cause depression,” says Nelligan. That may be why a significant number of people with psoriatic arthritis – more than 20% – have depression, according to one study.

Managing Painful Emotions

When you’re in a good place emotionally, it’s easier to withstand the challenges your disease can cause, whether it’s the stare of a supermarket cashier, or the downplaying of your symptoms by a well-meaning relative.

How can you become more emotionally resilient? Start by talking with someone who understands both psoriasis and the depression it can cause. Find a psychologist who works with people who have chronic conditions. You can get a referral from your doctor, or search online resources, such as Health Grades and Psychology Today.

You can also get emotional support from a peer. The National Psoriasis Foundation offers a One to One mentoring program that pairs you with another psoriatic arthritis patient – someone who knows what it’s like to deal with this disease every day. You can also find a support group online or locally, which will give you access to people who’ve been through similar experiences. “I think it’s really helpful to talk to somebody who gets it,” Nelligan says.

Try to stay involved, even if you don’t feel up to it. Getting out can distract you from the pain and fatigue. If you don’t feel well enough to venture out, call or text a friend to stay connected. Nelligan also recommends keeping a journal to express your emotions, and to record your symptoms so you can start to understand your limitations and work around them.

Another way to beat the blues is with exercise. Physical activity not only relieves soreness and stiffness, but it also releases brain chemicals that boost mood. You don’t have to take an hour-long spin class to see benefits. A 10-minute daily walk or swim can do wonders for both your physical and mental state. An activity like yoga or tai chi combines exercise and relaxation to simultaneously combat pain, stiffness, fatigue and depression. Choose whichever program best fits your abilities.

Finally, don’t be too hard on yourself when fatigue or pain interrupts your life. “Just be compassionate toward yourself for what’s happening, because it’s not your fault,” Nelligan advises.

14 thoughts on “The Emotional Toll of Psoriatic Arthritis”

Thank you for sharing this. I have had psoriatic arthritis for almost 10 years now, and just added MS to the mix. Another disease de jour…..I am having a hard time putting it all together, actually. I look forward to starting my MS medicine, it’s been a long time coming, and will have some serious PT to help the arthritis, the MS, the osteoporosis, the Menier’s, etc. I have applied for the paratransit (the little bus), because I can’t drive anymore due to vision problems. Sounds like a pity party…..thanks again.

I have severe pain in my left shoulder and left knee. Still ride my Harley motorcycle , dig for gold , fish , camp and hunt introduced pests. In between bad days I do these activities as I will not let this horrible disease get to me.

I suffered with psoriasis on my palms and elbows and cracks in heels for 50 years. I also had pain in my right hip after sitting for a while and would limp for a while upon standing. I was also bothered with dry eye. I love shrimp and ate it often and decided to stop for a while because I knew it could cause allergies. When I stopped eating shrimp, everything improved a lot!! I went to the dermatologist asking for confirmation of my belief that I was allergic to shrimp. The test came back negative, but he told me to be careful. Whenever I ate shrimp, symptoms would return.
Then my daughter was diagnosed with a nickel allergy and was given a list of foods high in nickel. I had also been diagnosed with a nickel allergy 50 years ago, but was never told it was in food. Shrimp was on the list of foods containing lots of nickel!!! Hope this helps someone.

what happens when you have medicare and as a back up Aetna you can not find a doctor who can help you. The pain clinics are glad to see you, they can turn you into a junkie, who wants that. I have 2 dogs and 2 horses and can’t find a doctor. I don’t know what I am suppose to do. I fall on average of once a month and the last time really did some damage. I don’t want to use emergency rooms. I am 66 years old and have been dealing with this since 1991. Had good insurance then and was on Enbrel but now it would cost me $1,037.30 monthly. Don’t qualify for any of the programs so just stuck. Any advice would help because going down hill fast.

This is very helpful to me! I have PsA and you described what I feel daily. I well was and still have my nursing license, but it’s like my auto immune system kicked my tail over the past yr and a half. And then apparently a digestive problems developed too and it all started really slowing me down at work. Depression , very much has impacted my life because I have cheered for 10 yes and been a very active and independent person. I hate to ask for help. But I really found your article helpful! Thanks so much!! Trina:)

I,m on my third biologic and I don’t think it,s working,I,m in bed and it,s beautiful outside.I,m in so much pain as write this,I,m nauseous which happens a lot .I havn,t used Prednizone in quite a while because it drove my blood suger up but I,m on insulin no for type 2 so maybe that will help plus I need a break,what I mean is that I,m in pain every day, I have to use opiates but use less than prescribed because I hate being zonked all the time,to tell you the truth I,m scared to death,I,m in serious pain all the time,it’s even affecting my sleep now.I had a mentor for a number of years,I met him fishing,he,s got the desease worse than me but I got rid of him last year,he,s a cheap prick and a real asshole,it start to affect me mentally,anxiety attacks.Just what I needed.Anyway,I,ve done nothing this summer,it so bad I,m starting to have major problems even driving a car. I was 60 last Fall and was an avid Hunter and Fly Fisherman and I,m afraid it,s all over,it,s just to much.I WISH .

I have Hemochromatosis. This causes Arthritis as well. I suspect I might have Psoriatic Arthritis. I have been blaming the hemochromatosis for this. My Doctor already diagnosed psoriasis. My hands and feet keep going through a peeling and dryness period, every few months. My fingers in the last few months have become very stiff, where I cant clench a fist in the morning. It improves through the day. A few of my finger nails have changed where I have ridges on them. My joints on both sides of my body are painful. Thigh, knees and toes.The bottom of my feet are very painful. Toes are starting to be painful as well.

Even my rheumatologist years ago misdiagnosed me as did the next one. My general practitioner suspected I had PsA but didn’t overuse them. Finally a new rheumatologist got it right. Everything makes sense now even the depression. Years of misdiagnosis have left me with some joint damage. At 65 I still work full time but it is hard. My time off is spent resting and taking care of my 2 yr old grandson who lives with me. That’s why I still work to provide for him but he is my joy. I would say to doctors… Listen to your patients. They already feel bad enough not being understood by family and friends.

Thank you for sending this. I think it’s important that doctors who treat patients with this disease are aware of the emotional impact it has on each individual. As an individual who was diagnosed with Psoriatic Arthritis at the age of 16 and has had the disease for over 50 years – I can honestly say, this disease does have an emotional impact. Every few years a new remedy comes along – and for decades I tried everything to the point where many of the prescribed medicines or treatments have left me with even more medical issues – skin cancer, melanoma surgeries, bruising of skin, deformed joints (too many cortisone shots), etc. It is no wonder that I am skeptical of new drugs until they have been used for several years. But some doctors simply do not understand why I would be concerned about this. Just as a point of interest, when I was 16 living in Cleveland, my doctors injected my knees, ankles, toes, shoulders, wrists, etc with cortisone to the pont that I had countless injections which have now deformed my toes – and I am now in physical therapy weekly for the past 10 years. The doctors told my parents that I should go to college in Florida – that the sun would be most beneficial – and it was! I went to the University of Miami and with weekend trips to the beach – my psoriasis disappeared and I had hardly any arthritis symptoms. But then years later have two years of PUVA treaments in San Diego – the Melanomas began to appear. More surgeries. And then a bout of Cellulitis – so I was told I could not take biologicals. Now I’m told I should take a new drug which has a TV commercial with a happy dancing girl in it – with the side effects including possible depression, suicidal thoughts, diarrhea, etc. When I told one of my doctors that I don’t think I can take the drug now – his response was that I never want to take anything he prescribes. But perhaps there is a reason.

Thanks so much for the Psoriatic arthritis information! I have Psoriatic arthritis and it’s a frustrating condition! Family doesn’t understand how I feel or how fatigued I get! I live in Canada and find your articles so informative. I love reading your emails.